Learning and gaining familiarity with different types and morphologies of damaged red blood cells may aid in the diagnosis of anemia. Finally, the underlying cause of anemia can be narrowed further by ordering a stool guaiac test, which helps rule out blood loss, or a bone marrow biopsy, which helps to identify metastatic disease and hematologic malignancies. Read next. August 03, Receive an email when new articles are posted on. Please provide your email address to receive an email when new articles are posted on.
You've successfully added to your alerts. You will receive an email when new content is published. Click Here to Manage Email Alerts. We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice slackinc. Back to Healio. Could the warfarin be responsible for a slow bleed that she would be unaware of? Thanks in advance:. Your mother is currently seeing the right specialists to address your concerns.
I would encourage you to ask them to clarify why they think she is anemic and iron-deficient. The gastroenterologist should also be able to address your concern about whether she might have colo-rectal cancer, despite her so-far reassuring test results. It has been as high as 6, but mostly around the 4 range. Her inr has become more unstable this year and she seen an increase in bleeds into her eye and bruising. Thank you for your help. An unstable or frequently high INR sounds concerning.
I would encourage you to bring it up with her doctors, especially the one who prescribes her warfarin or who initially recommended she be on it. Many people take warfarin related to a heart condition, but the prescription is often written by the PCP. Warfarin is one of the top drugs for causing ER visits, hospitalizations, and complications, mainly because it can be a challenge to keep people within the safe range.
You might want to ask whether it might be possible to switch her to one of the newer blood thinning agents, such as dabigatran or apixaban Pradaxa or Eliquis. These newer medications do not fluctuate in the body the way warfarin can, so these can be a safer choice for some older people.
It should be possible to reduce her bleeding risk, either by helping her better manage her INR levels or by switching to a different anticoagulant. Your website very helpful. Score was I am 72 and in good health otherwise. He started me on iron — 2 per day. This past week has been very very difficult. I have weakness and fatigue.
I have 2 questions. First, how long does it take to start feeling better after taking iron. Thank you for your kind help. I would encourage you to contact your doctors as soon as possible, and let them know you are feeling weak and doing worse than before. Also be sure that your doctors explain to you why they think you have lost blood or otherwise become iron deficient. Once the cause of blood loss has been fixed, then if anemia is due to iron-deficiency, the blood count should improve within months.
My father is He has hemoglobin level of His RBC count is a bit higher than normal range. Doctor gave him mg iron drip 2 weeks back. His Hemoglobin level is still We often give a fixed dose of approximately mg, which is generally sufficient to treat anemia typical red blood cell iron deficit between and mg and provide additional storage iron without causing iron overload.
Also, apparently IV iron interferes with most tests related to iron studies, so iron levels are not repeated during the month after administration of IV iron. Usually, the hemoglobin level starts to slowly improve after weeks, and one should see substantial improvement after one month. What medicine should I prefer? Is it danger to eat plenty? Eating slate pencils sounds like a condition called pica, which means craving and consuming non-food items.
Pica is associated with iron-deficiency anemia and other micronutrient deficiencies. It is unclear how often pica might cause deficiencies versus it being more a symptom caused the deficiencies. You can learn more here: A meta-analysis of pica and micronutrient status. If you have anemia or blood loss, you need a thorough evaluation as described in the article, to determine what is the most likely cause of your low red blood cell count.
It is impossible to know which medication or treatment is suitable until the underlying problem has been correctly diagnosed. Be sure to mention to your doctors that you have been eating slate pencils. The doctor told us she has severe Anemia.
She refuses to eat anything. Also she caughs a lot nowadays. She has lost all of her weight and is always exhausted. Is that normal? It sounds like your mother has lost her appetite for some reason. If someone has such symptoms plus coughing, normally we would investigate for serious underlying illnesses, especially those in the chest or lungs. Usually the first step is a chest xray, and then possibly a CT. This can help rule out problems such as tuberculosis and certain cancers. Please note that I am not saying that she has a serious condition such as this, only that the symptoms you describe usually warrant some preliminary testing to check for such serious conditions.
Be sure to ask your doctor what tests were done and which findings, other than low hemoglobin, were abnormal. In order to help your mother get better, you will first need to learn more about what is causing her symptoms.
Generally the best way to do this is to ask her doctors lots of questions and also keep doing your own research. I do have an article on unintentional weight loss in older adults, see here: What to Do About Unintentional Weight Loss.
My mom is 94 and in a nursing home. She was recently diagnosed with pneumonia. They are also treating her with antibiotics for the pneumonia.
She has vomited several times after taking meds. When she is not sleeping, she is often agitated and confused. I want her to be comfortable but do not want to prolong her life.
Is there a reason I should continue the iron supplements? Yikes, that is pretty severe anemia. In my experience, if anemia is that profound and the goal is to try to extend life, then one needs to pursue a transfusion in the short-term. And that would be assuming that iron-deficiency is the main cause of the anemia and that the blood loss has stopped, which is often NOT the case for people like your mom.
However, if the goal for your mother is to keep her comfortable, then all that iron supplementation is unlikely to do that; it may well be contributing to her vomiting. Given her age and profound anemia, she is probably eligible for hospice care, and that is an excellent way to get medical care that focuses on comfort and managing symptoms, rather than trying against the odds to keep a person alive. You are absolutely doing the right thing in questioning what they are doing and researching other options.
Keep going and good luck! Hello mam I have haemogolobin 5. I gone through blood transfusion and then my haemogolobin is 9. I start to take iron pills on recommendation of doctor and eating more fruits and green vegetables.
Now my haemogolobin 4 days ago is I have bad habit of not eating….. Sorry that you have been having these health difficulties, but good that your hemoglobin is much improved. If your doctor is unable to find a reason, you may want to get a second opinion.
My mom is 72 years old and has been receiving blood transfusion on a monthly basis since May due to anemia. On top of this, she receives weekly injection of epokine units. It is exhausting for her; she is experiencing shortness of breath and fatigue.
Her doctor has been recommending bone marrow test but my mom is so weak to undergo such invasive procedure. Just recently, we had her examine by a new doctor; stool exam was done and results show:. I hate to think that we will result in getting her undergo a bone marrow test; is there any other tests we can do first?
What we notice too that in the last two months, we needed to have her blood transfusion done earlier less than one month interval. A bone marrow biopsy is an important test, because it will provide a lot of information on what might be going wrong.
A bone marrow biopsy is usually recommended after a peripheral smear suggests that there is a bone marrow problem. Your mother sounds like she is experiencing a lot of symptoms from her anemia. She just had another blood transfusion and we requested to get her ferritin test done early this week. We got an approval for this test but we are wondering if the recent blood transfusion may interfere with result of the ferritin test.
More power to you and thank you very much for running this website. It is indeed an excellent website. According to this study, transfusion does not quickly change levels of ferritin, vitamin B12, or folate: The effects of blood transfusion on serum ferritin, folic acid, and cobalamin levels. My friend,60 year old female was treated for severe anemia for over 18 months during which time they tried iron suppliments,checked for bleeding and gave her monthly infusions because the hemoglobin was usually down to There had been times when she passed out and had to be transported by ambulance to the ER where they gave her blood and discharged her.
Finally she changed doctors. A month later she was admitted to the hospital with a 2. The AML was resistant to chemo because of an invered 3 chromsone. She is now receiving alternate less strength chemo. Should not a bone marrow biopsy or reticulocyte count have been down at the very beginning? Why go almost 2 years with infusions instead of determining the reason for the low hemoglobin levels? And to top it off the original treatment was with another cancer center.
My mum diagnosed with myeloma last November. She has had two bone marrow biopsies and skelaton xray. No chemo as mum still able to do homebaking herself but had first blood transfusion when her reading dropped to 8.
She is fine but they seem to be pushing her to go unto Aranesp mg injections which we as family after researching think is not great option. She has had Mini stroke shortness of breath clots etc in past and think tranfusions would be safer option. It sounds like you are researching options, which is exactly the right thing to do. I would recommend searching very high-quality sources of information on myeloma treatment, such as review articles in reputable journals.
A second opinion from a doctor specialized in blood cell cancers may also help. In , I came down with a crash! After that, a long painful uptake with a strict diet and spirullin kept me fatigued, depressed with skin outbreaks, hair loss, and general weakness for over two years. In , I started slowly to get better, with 20 ferritin, 24 iron but only An anemic person should give up coffee, black tea, alcohol, and preferably stick to a dissociated diet.
And outdoor activities pumps the lungs and strengthens mind and body. Dietary changes to treat anemia really depend on what caused the anemia in the first place. I am not aware of any studies indicating that people with anemia should give up caffeine or alcohol. Per the Mayo Clinic website , iron supplements are best absorbed on an empty stomach but may be taken with food in order to reduce stomach upset. I received iron transfusion not blood transfusion.
A transfusion will raise the hemoglobin quickly, whereas treating iron-deficiency or other underlying causes of anemia often takes weeks. A transfusion is only a temporary fix, however.
My haemogolobin was 5. And used to eat fried and spicy foods????? Can nutritional deficiency can be a reason????? You should ask your doctors to clarify why they think you became anemic, so that you can avoid recurrence of your anemia.
Meat does contain iron and also vitamin B Both of these are necessary to make red blood cells. If you plan to remain vegetarian, be sure to ask your doctors to help you identify other ways to get these nutrients.
You may need to take iron supplementation indefinitely, if you have no dietary source of iron. I became anemic twice when I was a vegetarian, although with a better diet than Rajat. The first time my mother was overdosing us on zinc supplements, which binds with all heavy metals including iron.
Learned about zinc issue from reading further than Prevention magazine. The second time was in Germany after a winter of drinking retsina in Greece in The naturopathic doctor in Germany recommended steamed stinging nettles, richest plant source of iron. Pick them with gloves, from an isolated location, or buy dried.
Rapid improvement. Thanks for sharing your story. In most people, oral iron supplements are an effective way to treat iron deficiency. However, certain foods interfere with iron absorption and medications that interfere with stomach acidity may also reduce absorption. It is also very common for people to experience unpleasant gastrointestinal side-effects from iron supplements. Generally, the higher the dose of elemental iron in the supplement, the more likely people are to experience side-effects.
Plants do contain iron but it is non-heme iron, which is actually less well absorbed by the body than the heme iron which is in meat. A key to treating any type of iron deficiency is to check on how well the treatment is working, within a few weeks. If a person is able to raise or maintain their iron levels with a certain dietary approach, then additional iron supplementation may not be necessary.
This is a follow-up query on the case referred by Ms. Elaisa Tubana I am her aunt about my mother, 72 yrs old, who is suffering from anemia, and requires blood transfusion almost twice a month recently and a weekly injection of epokine. We would like to know if its a must to have eight common follow-up test you mentioned above prior to bone marrow test. Accordingly, my mother do not have ferritin test yet. She only have so far the CBC which yield result on reticulocyte.
Is it similar to peripheral smear. My mother will be having another blood transfusion this coming October 7 , including epokine injection. Likewise, the doctor is advising her to have the bone marrow test after the blood transfusion. Kindly enlighten us on this. We need direction of whether we will proceed with the bone marrow test or have these 8 common follow-up tests first. Thank you and God bless. I will say that in the U. A bone marrow biopsy is usually done after other tests have suggested a problem in the bone marrow.
The purpose of this site is to provide information and education only, to help people ask better questions of their health providers. Otherwise, for more specific direction, you would need to get a second opinion from a doctor who can work with your family in person, to examine your mother and review her test results so far. My mother is 83 years old. She was dignosed with urinary tract infection.
Her HGB level was 7. Does She need to improve HGB with injecting venofer? A urinary tract infection, in of itself, does not generally cause anemia, and usually treating a UTI does not, in of itself, cure anemia or raise the hemoglobin level. Venofer is an iron infusion. Similarly, whether the hemoglobin will improve on its own depends on why it went down in the first place.
If the problem was a bleed and the bleeding is stopped and the person has a well-functioning bone marrow and adequate iron stores, the body will eventually correct the anemia on its own. Last stage of Alzheimer, confined to wheelchair. Has had CLL for over 30 years, but no tx, just monitoring.
Three days ago, severe bruising appeared between morning and bedtime. Her right shoulder and chest were purple and the bruising progressed down her arm. CBC done….. WBC Can bruises appear spontaneously? Your article is very informative and I have copied the questions to ask about her anemia with the facility doctor. Yes, it is possible for bruises to appear spontaneously.
One potential cause is developing a low platelet count, which can happen with certain illnesses or serious conditions. The Mayo Clinic has a good article on bruising in late life here: Easy bruising: Why does it happen.
They will also provide some support for you. My mother age 64 years has HB level 8. Now we are worried whether we should go ahead with this injection or not with the 2nd doctor telling this is a risky injection.
I googled up what cause of anemia is treated using this injection and it looks like this is when kidney is not producing some required hormone related to red cell production, when person has some kidney related disease. My mother never had any kidney disease and I suspect the doctor just prescribed the drugs based on 2 most common causes of anemia in elderly people.
My mother is a diabetes patient and takes medicines for diabetes, blood pressure and thyroid in routine. Doctor 1 who prescribed her medications is aware of her medical history and all the earlier medicines for these things have also been prescribed by him. Can sometime tell me about the potential risks of this this injection Vintor IU and how risky it can be in worst case? Can my mother try some other things or tests to treat her low HB levels and get rid of the fatigue and tiredness she experiences daily?
Is is possible to get the HB level improved or back to normal through natural things like diet and may be mild and relatively harmless supplements only? The brand names you describe are not used in the US. It looks like Pevesca is alpha-linoic acid, which is an antioxidant sometimes used to treat diabetic neuropathy. You can ask the prescribing doctor if this is meant to treat anemia or some other problem your mother may be experiencing.
As for Vintor, seems this is erythropoietin. People who develop chronic kidney disease may have lower than normal epo levels, which can cause or worsen anemia. In the US, epo is mainly used to treat anemia that is associated with chronic kidney disease, or otherwise seems to be related to low levels of epo. It is possible to test blood levels of epo, but usually this is only considered if the person already shows signs of a condition associated with low epo.
This will help you understand whether treatment with epo is likely to help, and you can ask about the associated risks at that time. Many people with diabetes do develop some chronic kidney disease, so you should confirm your mother shows no signs of that on her labs. Chronic kidney disease is usually associated with higher than normal creatinine and blood urea nitrogen, and also lower than normal glomerular filtration rates.
My mother has today taken 3rd of the 4 weekly injections prescribed. She is complaining that she is feeling even more tiredness than earlier after taking these injections so far. So tomorrow we will get her HP count checked from lab.
The doctor prescribing her erythropoietin would be better qualified to answer your question. The bone marrow usually takes about a week to create new blood cells, so presumably one should see some effect of this type of medication within a few weeks. Absolutely, by far, you are the best!! Thank you for this comment.
So glad you are finding this helpful. Can you review the bed bug article s and comment? A third unexplained in wake of current epidemic is outrageous, the insects have the ability to impact platelet count. Would you support an evidenced based policy for reporting? I think this is an exception, privacy rights need strengthening and subsidy for poor is sufficient incentive for self reporting, if privacy is respected!
State medicaid could save so much if they intervened early. I have met a lady who broke her back fallijg out of bed, and believe it was bugs that had her dauhter witlessly spend ten grand on lawyer to liquidate and sti ck her into semiprivate hell forever.
The daughter confessed infestation etc. If excessive lab draws can effect CBC then thousands of animals sure can, and maybe costing golden decades. Although it is still within the healthy range as told by my doctor, which is , I am a bit worried. My doctor said there is no need to worry because the overall index is still within the healthy range. As I grow older, does that mean my overall white blood cells will decline?
What are the food to take fo increase my white blood cells, in pariicular Neutropjils and Lymphocytes? Presumably this is because higher WBC counts can correspond to inflammation. Causes, consequences, and reversal of immune system aging. Presumably exercise, enough sleep, a healthy diet, social relationships, and all the other things we know are good for older people can help maintain the immune system.
Regarding vitamin B12, if you have concerns about deficiency then I recommend talking to your doctor about whether it might be possible to have your level checked. I will continue to monitor closely my TWC and the proportion of each different type of white blood cells in the sample for the coming years. Haemoglobin 3. I will say that a hemoglobin of 4 is very very low, and in most cases such a low level prompts immediate transfusion.
Therefore, she has to take omeprazole pills, about 2 or 3 times per day for few years since Once she stop taking or skip the pills for few days, she will develop symptoms like heartburn and her heart beat very fast.
This article is about anemia, not GERD. Some people do need to take proton-pump inhibitors PPIs such as omeprazole indefinitely but some patients are able to taper off of them. Hi, I recently had blood tests for symptoms of thrush and frozen shoulder and rang up for the results. The receptionist told me that all was normal but my ferritin level was 10 and the doctor hadn,t reported on it yet. What does that mean. I have been told to ring back in a few days.
I am a 66 year old female. A ferritin of 10 is pretty low, and is most commonly caused by iron deficiency. Good luck and I hope your doctor is able to answer your questions and pursue further evaluation as needed. Can aspirin in general, and when taken at 3,mg daily for 2 weeks, cause anemia? Can any of the following meds they were taken at the same time as the 2 wk aspirin regimen cause anemia?
Maybe the med combos can cause anemia…? Many thanks for this column and for offering interaction. It gives so many of us knowledge, empowerment and hope! Taking that much aspirin every day sounds quite concerning to me. People can develop very serious acute aspirin toxicity by taking 10g of aspirin, so if a person were taking every day, I would be quite concerned about the possibility of chronic toxicity.
I have to urge you to contact your doctors right away to review your aspirin use. You may want to ask whether checking a blood salicylate level might be indicated. Otherwise, aspirin can cause anemia, usually by provoking bleeding. Good luck, take care, and be sure to discuss your aspirin use with a doctor or pharmacist before continuing to take this much daily aspirin. I would just like some insight about my father. He went to the doctor a few months ago, was diagnosed with anemia.
Well this week he went to the doctor because he was sick it was just a cold. They did blood work on him again. It came back that he is still anemic. They are sending him to a hematologist oncologist immediately. I do not have the numbers or any other specifics.
My dad is diabetic and has been for 25 or more years. My question is, just because they want to send him to an oncologist does that mean he might have cancer? I know a year or so ago he had a lower gi done and they put him on a watch. I appreciate your time. Hematology is the specialty related to blood cells and oncology is the specialty related to cancers. They have a lot of overlap, and there are some cancers of blood cells, such as leukemia. Historically hematology and oncology have been combined in a joint subspecialty internal medicine fellowship, so doctors will initially receive training in both specialties and then will take both the hematology board exam and the medical oncology board exam, so that they are board-certified in both specialties.
In practice, some doctors will do both hematology and oncology cases, but many end up focusing and re-certifying their boards in one or the other. So they are probably referring him to hematology, so that an expert in blood cell abnormalities can evaluate him. I will say that sometimes such blood cell abnormalities are related to some form of blood cell cancer, but there are other reasons for the various blood cells to look unusual.
I would recommend that you and your parents try to always ask extra questions when you are told something is going on, or is abnormal. This can be hard for older adults to do, so often adult children take on this role.
It sounds low but not very low. That is assuming a woman is not pregnant. Pregnancy causes some anemia. My mom has had smoldering myeloma for approximately 7 years now. Recently, she had a bone marrow aspiration because of a large drop in her hemoglobin, from She was rechecked two weeks later and it dropped to 9. The bone marrow did not show evidence of Myeloma at this point. She was also tested for myodyplastic syndrome and this was negative as well.
Doctor is stumped at this point. I believe blood loss is the most common cause of a sudden drop in hematocrit. If a person has normally functioning bone marrow, within a few days this should cause an increase in reticulocytes immature red blood cells , because the bone marrow will crank up red blood cell production in an attempt to compensate for the anemia. In her case, the recheck was in the same range 9. Hi Doctor, In my hb was around 10 and I have diagnosed with ITP later in the month of April hb becomes 9 and in June July it got down into 8 and in the month of November it further reduced to 7.
I have done endoscopy and colonoscopy where they have found helicobacter pylori like Bacteria. Now I have pain and cramps in stomach also I have hemorrhoids internal and external which is bleeding for last 6 years. Now I am really worried please reply me. Sorry that you are having these symptoms and low red blood cell counts, it certainly does sound worrisome. I am 77 years I have been getting procript injection for about 2 years every month then ever other month.
I went and had a knee replacement and hemogloblin went from Then I had a blood transfusion which got it up to My iron is good. I can not receive any more procript as insurance won.
My kidneys are at 40 percent. He says I am good but I still am concerned. Do you have any opinion? Procrit is epoetin, an erythropoiesis-stimulating agent. It seems that their target is based on their expert opinion and clinical experience, rather than on definitive randomized trials. You should discuss your concerns with your usual healthcare providers, as they know you and will also have relevant experience managing anemia in people with CKD.
If you are concerned about your hemoglobin dropping while you wait for your insurance to resume covering Procrit, I recommend letting your doctors know, and asking what would be a reasonable way to monitor for any worsening of anemia. My mom aged 46 is suffering from anemia 6. To increase blood levels. So I would recommend asking for more information on how they plan to do that.
Usually to reduce her bleeding, they would need to first determine what is causing such heavy uterine bleeding. For those who cannot tolerate oral iron, IV iron is sometimes required. Hello, and thank you for this useful information! I am a 66 year old woman and as a result of routine blood work done at my yearly physical, I found out that I have severe anemia. The original HGB level was 7. Shortly after this diagnosis, I went to the hospital with a bowel obstruction my third , where I was given an infusion of iron.
I am currently taking ferrex and have had an EGD and colonoscopy, both of which were normal. My RDW is high at My B12 and folate are normal. Your thoughts, please. Thank you so much. Please see this comment and the article below, regarding iron deficiency anemia when endoscopy is negative.
It is not terribly rare, and you may eventually need additional evaluation. Outcome of endoscopy-negative iron deficiency anemia in patients above I would basically recommend you keep asking your doctors lots of questions as to what they think is going on, and what they plan to do next. You may also want to consider a second opinion with either a hematologist or gastroenterologist. Shortness breath they say probably loss blood.
I check motion. Can I take alternative like iron iamgood ateating food with iron just needed some one to. Talk with as I live alone no family now yourhelp would be appreciated Ruby. For people with blood loss, iron is mainly helpful if they appear to be low on iron levels. If they tell you that you might benefit, but you might also be ok continuing as you are now, then you might feel better about what you are doing.
Whereas if they strongly urge you to get further evaluation, you should take that under careful consideration. Especially if you have no family to help you think through this situation, you may want to see if you can find an online or in-person support group to help you. You can connect with others who have a similar health condition at SmartPatients. Or a local center for older adults might have a group in which people can discuss health concerns and support each other.
My 92 year old father has had a decrease in hemoglobin. I have limited information. I believe his baseline is 9. He complained of itching and the doctor where he lives in senior living ordered blood tests. His hemoglobin came back 7. Apparently it was retested several days later and came back 6. The doctor wants to hospitalize him in order to do invasive tests to figure this out and after consulting with him and the rest of the family we have declined hospitalization.
What steps can we ask the doctor to take within his current living environment to diagnose what is wrong and keep him comfortable? Normocytic indices occur in anemias resulting from deficient erythropoietin EPO production or inadequate response to it hypoproliferative anemias. Hemorrhage, before iron deficiency develops, usually results in normocytic and normochromic anemia unless the number of large reticulocytes is excessive.
The peripheral smear is highly sensitive for excessive RBC production and hemolysis. It is more accurate than automated technologies for recognition of altered RBC structure, thrombocytopenia, nucleated RBCs, or immature granulocytes and can detect other abnormalities eg, malaria and other parasites, intracellular RBC or granulocyte inclusions that can occur despite normal automated blood cell counts. RBC injury may be identified by finding RBC fragments, portions of disrupted cells schistocytes , or evidence of significant membrane alterations from oval-shaped cells ovalocytes or spherocytic cells.
Target cells thin RBCs with a central dot of hemoglobin are RBCs with insufficient hemoglobin or excess cell membrane eg, due to hemoglobinopathies or liver disorders. The peripheral smear can also reveal variation in RBC shape poikilocytosis and size anisocytosis. The reticulocyte count is expressed as the percentage of reticulocytes normal range, 0. The reticulocyte count is a crucial test in the evaluation of anemia because it informs about the response of the bone marrow and facilitates differentiation between deficient erythropoiesis RBC production and excessive hemolysis RBC destruction as the cause of anemia.
For example, higher values indicate excessive production reticulocytosis ; in the presence of anemia, reticulocytosis suggests excessive RBC destruction. Low numbers in the presence of anemia indicate decreased RBC production. Reticulocytes are best visualized when blood is stained with a supravital stain, but because red cell reticulin is composed of RNA, which is present only in young red cells, they will have a bluish appearance in a Wright-stained blood smear polychromatophilia or polychromasia , which can provide a rough estimate of reticulocyte production on a routine blood smear.
Bone marrow aspiration and biopsy provide direct observation and assessment of RBC precursors. The presence of abnormal maturation dyspoiesis of blood cells and the amount, distribution, and cellular pattern of iron content can be assessed.
Bone marrow aspiration and biopsy are usually not indicated in the evaluation of anemia and are only done when one of the following conditions is present:. More than one cell lineage abnormality ie, concurrent anemia and thrombocytopenia or leukopenia.
Suspected primary bone marrow disorder eg, leukemia, multiple myeloma, aplastic anemia, myelodysplastic syndrome, metastatic carcinoma, myelofibrosis. Cytogenetic and molecular analyses can be done on aspirate material in hematopoietic or other tumors or in suspected congenital lesions of RBC precursors eg, Fanconi anemia. Flow cytometry can be done in suspected lymphoproliferative or myeloproliferative states to define the immunophenotype.
Bone marrow aspiration and biopsy are not technically difficult and do not pose significant risk of morbidity. These procedures are safe and helpful when hematologic disease is suspected. Both usually can be done as a single procedure. Because biopsy requires adequate bone depth, the sample is usually taken from the posterior or, less commonly, anterior iliac crest.
Serum bilirubin and lactate dehydrogenase LDH can sometimes help differentiate between hemolysis and blood loss; both are elevated in hemolysis and normal in blood loss. Other tests, such as vitamin B12 and folate levels, iron and iron binding capacity, are done depending on the suspected cause of anemia.
Other tests are discussed under specific anemias and bleeding disorders. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world. The Manual was first published in as a service to the community. Learn more about our commitment to Global Medical Knowledge. This site complies with the HONcode standard for trustworthy health information: verify here.
Common Health Topics. Videos Figures Images Quizzes Symptoms. Risk factors for anemia Symptoms of anemia Symptoms that suggest cause of anemia. Physical Examination. Complete blood count and RBC indices Peripheral smear Reticulocyte count Bone marrow aspiration and biopsy Other tests for evaluation of anemia. Approach to the Patient With Anemia. Test your knowledge. Abnormal bleeding can result from disorders of the coagulation system, of platelets, or of blood vessels.
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